Healthcare Student Immunizations: An Overview

Internet Journal of Allied Health Sciences and Practice Volume 13 | Number 4 Article 4 10-9-2015 Healthcare Student Immunizations: An Overview Douglas Gardenhire Georgia State University, Follow this and additional works at: https://nsuworks.nova.edu/ijahsp Part of the Health and Physical Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Gardenhire D. Healthcare Student Immunizations: An Overview. The Internet Journal of Allied Health Sciences and Practice. 2015 Oct 09;13(4), Article 4. This Manuscript is brought to you for free and open access by the College of Health Care Sciences at NSUWorks. It has been accepted for inclusion in Internet Journal of Allied Health Sciences and Practice by an authorized editor of NSUWorks. For more information, please contact . Healthcare Student Immunizations: An Overview All clinical healthcare programs (CHP) in the United States require documentation of many types of immunizations and health information. The key for CHP personnel is to determine if immunization and health information is valid or if immunity exists. Documentation alone does not guarantee a student will be protected. This document will review common immunization and health information collected by many CHP and provide recommendations that programs may consider when adopting or changing polices on student immunization and health information. Author Bio(s) Douglas Gardenhire, EdD, RRT-NPS, FAARC, is interim chair of the Department of Respiratory Therapy at Georgia State University. This manuscript is available in Internet Journal of Allied Health Sciences and Practice: https://nsuworks.nova.edu/ijahsp/vol13/iss4/4 Dedicated to allied health professional practice and education Vol. 13 No. 4 ISSN 1540-580X Healthcare Student Immunizations: An Overview Douglas Gardenhire, EdD, RRT. Georgia State University United States INTRODUCTION The collection of immunization records in the United State (U.S.) starts for most individuals no later than kindergarten. All states and U.S. territories have enacted laws governing immunizations to protect the welfare of society.1 Many states have exemptions based on medical, religious, and philosophical aims given proper documentation. 2 Because of variations of law and exemptions, CHPs may find student’s health records convoluted. Immunization history and the health of students play an integral role in all CHPs placing students at clinical sites. CHPs often require different health and immunization documentation than state requirements. This paper looks at the issues associated with student health and immunization records and how it impacts the student and the school with recommendations CHPs may use for clinical placement. HEALTH REQUIRMENTS The most commonly required immunizations for CHP students may include documentation of measles, mumps, and rubella (MMR), a three part series for hepatitis B, varicella, tetanus/diphtheria acellular pertussis (Tdap), a tuberculosis (TB) skin test and influenza. Details for each will be discussed below. Measles, Mumps, and Rubella (MMR) The Edmonston measles vaccine was licensed in 1963. Following successful use of the vaccine, the mumps vaccine was licensed in 1967 while rubella (German measles) followed in 1969. As a result of the success of these individual vaccines, the combination of all three, measles, mumps, and rubella (MMR), was made available in 1971.3 The MMR vaccine is administered by a subcutaneous injection within the first year of life. One dose provides immunity for most individuals receiving the vaccination; however, a small number of patients do not develop immunity after receiving the first dose, so a second is routinely administered at 4-6 years of age to ensure the vaccine's total efficacy. The Centers for Disease Control (CDC) recommends two doses of MMR.1 CHPs placing students into clinical rotations should require documented evidence through a serology report showing immunity for measles, mumps, and rubella. The CDC recommends a healthcare worker (HCW) born before 1957 that cannot not provide evidence of immunity to have two equally spaced doses of MMR. The two doses can be given as close as one month apart.4,5 However, for a HCW born after 1957, the CDC recommends those with documented evidence of two shots would suffice for immunity, even if serology determines negative or equivocal results.4,5 The overall incidence of these diseases has resulted in a perception of low risk; however, the current measles outbreak, which is attributed to Disney Land, California, continues to produce new cases regularly across the U.S. Another outbreak of measles occurred in Indiana in 2011, which was the largest outbreak since 1997.6 CHPs should consider having all students provide a serology report for measles, mumps, and rubella. If negative or equivocal results are reported it may be wise to consider a single dose of MMR before clinical placement. © The Internet Journal of Allied Health Sciences and Practice, 2015 Healthcare Student Immunizations: An Overview 2 Hepatitis B Hepatitis B virus is an infection that targets the liver. It is spread by contact with infected blood and body fluids. Acute infectious symptoms may include fever, nausea, vomiting, muscle aches, and jaundice. Chronic infection can lead to cirrhosis of the liver.7 The hepatitis B antigen was discovered by Baruch Blumberg in 1966. Irving Millman developed a blood test to screen for hepatitis B that has been in use since 1971. It was not until 1981 that a plasma-based vaccine was available. In 1986, the vaccine was synthetically engineered to contain no human products.7 In 1991, the increasing outbreak of human immunodeficiency virus (HIV) and reluctance of adult populations at risk to be vaccinated for hepatitis B resulted in a recommendation by the CDC to immunize newborns.1 Hepatitis B can be spread by blood and body fluids. Since a HCW may be exposed, it is recommended they have documented evidence and immunity to hepatitis B. If a HCW cannot provide evidence, a three dose hepatitis B series should be given with dose one given immediately, dose two given one month later and the final dose given 5 months after the second. The individual should have immunity confirmed one to two months after the series has been completed. 4,5 CHPs should treat students in a similar fashion; however, immunity should be confirmed before clinical placement to determine if additional vaccination is required. Varicella Chickenpox is an airborne virus caused by the varicella zoster virus. The virus produces a blister-containing rash on the body and can also be found in the mouth. It is spread easily by coughing, sneezing, or direct contact with fluid from broken skin lesions (blisters). Symptoms include low-grade fever, nausea, and muscle aches, followed by the presence of the rash on the skin. 8 Michiaki Takahashi developed the first varicella vaccine in 1974. It was not until 1995 that the U. (...truncated)